Amendment ID: S3290-1

Amendment 1

340B Drug Pricing Program

Ms. Friedman and Mr. Moore move that the proposed new text be amended by inserting after section 157 the following section:-

SECTION 157A. (a) Notwithstanding section 13L of chapter 118E of the General Laws, or any other general or special law to the contrary, the executive office of health and human services shall not, directly or through a managed care entity, implement or enforce, a general exclusion from coverage of, or a general limitation on reimbursement for, drugs acquired through the federal 340B Drug Pricing Program under 42 U.S.C. §256b and dispensed through a pharmacy to MassHealth members enrolled in a managed care entity, including any exclusion or limitation achieved by removing pharmacy coverage from or otherwise transferring to MassHealth all or substantially all of the pharmacy benefit under a MassHealth managed-care arrangement, until: (i) expenditure authority under section 1115 of the Social Security Act, 42 U.S.C. §1315, for a 340B hospital access stabilization payment program, or a program substantially similar in purpose, as requested in the commonwealth’s request to extend the MassHealth Section 1115 Demonstration beyond December 31, 2027, has been approved by the federal Centers for Medicare and Medicaid Services and has taken effect; and (ii) the executive office of health and human services has submitted the report required under subsection (b). Nothing in the subsection shall prohibit the continued implementation or enforcement of any policy in effect on October 1, 2026.

 (b) Not less than 180 days before the effective date of any proposed general exclusion, limitation or transfer described in subsection (a), the executive office of health and human services shall submit a report to the chairs of the joint committee on health care financing and the house and senate committees on ways and means that shall include the following information: (i) the fiscal, operational and patient access impacts of the proposed change; (ii) the projected gross and net state and federal fiscal effects of the proposed change, including all underlying assumptions, methodology and anticipated timeframes; (iii) the estimated financial and operational impact on federally qualified community health centers and hospitals, including, but not limited to, changes in drug acquisition costs, cash flow implications, reimbursement variability, associated risks to providers, including potential financial losses, and the administrative and operational burdens of implementation; and (iv) the manner in which the executive office of health and human services plans to mitigate the impacts described in clause (iii), including the amount, source, duration and federal matching treatment of any mitigation funding, including the 340B hospital access stabilization payment authority.

 (c) Nothing in this section shall be construed to: (i) limit the executive office of health and human services in negotiations with, making commitments to or seeking any approval from the federal Centers for Medicare and Medicaid Services; or (ii) prohibit the executive office of health and human services from implementing any changes other than the general exclusion, limitation or transfer described in subsection (a) that the executive office of health and human services deems necessary to maintain the fiscal sustainability of the MassHealth program, including the designation of specific drugs acquired through the federal 340B Drug Pricing Program, on a drug-by-drug basis, for exclusion from coverage or reimbursement; provided, that such changes shall not, in the aggregate, have substantially the same effect as a general exclusion, limitation or transfer described in subsection (a).